1. INTERPRETERS AND TRANSLATORS IN HEALTH CARE Wilma Alvarado-Little, MA National Council on Interpreting in Health Care April 25, 2007 New York State Conference on Increasing Language Access to Healthcare: Toward Effective State and National Policies

2. Increasing Language Access to Healthcare How to determine if an interpreter or translator is qualified How to determine if an interpreter or translator is qualified Certification, testing and educational programs for training staff as interpreters and translators Certification, testing and educational programs for training staff as interpreters and translators Criteria for contract interpreters and translators Criteria for contract interpreters and translators How to effectively utilize community-based interpreters How to effectively utilize community-based interpreters The role of the National Council on Interpreting in Health Care The role of the National Council on Interpreting in Health Care INTERPRETERS AND TRANSLATORS IN HEALTH CARE

3. Increasing Language Access in Healthcare Staff interpreters: Staff interpreters: on call, contingency, bilingual employees, sign language Telephonic Telephonic Agency Agency Community based organizations Community based organizations Volunteer: employee Vs. non gratuitous staff Volunteer: employee Vs. non gratuitous staff INTERPRETERS AND TRANSLATORS IN HEALTH CARE

4. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE INTERPRETER CODE OF ETHICS  CHIA  IMIA  NCIHC  BRIDGING THE GAP

5. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE Some roles of a medical interpreter –Conduit –Clarifier –Educator –Cultural Broker –Advocate

6. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE Different name for a role, similar role! Don’t be afraid to ask !

7. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE How to determine if an interpreter or translator is qualified: Educational Requirements Educational Requirements Oral and/or written assessment Oral and/or written assessment Experience in the medical field Experience in the medical field Training in Interpretation & Medical Terminology Training in Interpretation & Medical Terminology Ethical dilemmas and the awareness of the different roles Ethical dilemmas and the awareness of the different roles

8. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE Certification, testing and educational programs for training staff as interpreters and translators Translators Expertise to conduct written translations Expertise to conduct written translations Knowledge of the culture of the population served Knowledge of the culture of the population served Cost - i.e per word, editing, formatting Cost - i.e per word, editing, formatting

9. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE Criteria for contract interpreters and translators Insurance Insurance Training program Training program Flexibility Flexibility Awareness of population served Awareness of population served

10. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE Criteria for contract interpreters and translators Language Interpreters Language Interpreters Qualifications/Training Qualifications/Training Experience in the medical field? Experience in the medical field? Rates... Additional fees i.e. Late emergency fees, travel fees, evening fees, weekends/holidays Rates... Additional fees i.e. Late emergency fees, travel fees, evening fees, weekends/holidays Availability i.e. Requests in advance at least 24 hours Availability i.e. Requests in advance at least 24 hours Immediate availability? Immediate availability? Contracts?..i.e. Per event, annual (#of minimum of hours per month) Contracts?..i.e. Per event, annual (#of minimum of hours per month)

11. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE Criteria for telephonic interpreting Rates- Increments vs flat fee Rates- Increments vs flat fee Languages Languages Contracts Contracts Equipment – double receiver vs cordless vs portable Equipment – double receiver vs cordless vs portable Tracking of calls – monthly vs quarterly Tracking of calls – monthly vs quarterly Training Training Terminology Terminology Style- consecutive vs simultaneous Style- consecutive vs simultaneous Customer Service Customer Service

12. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE How to effectively utilize community-based interpreters Community-based organizations Community-based organizations Mutual understanding of roles Mutual understanding of roles Compensation for services Compensation for services Dual role Dual role

13. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE The role of the National Council on Interpreting in Health Care The NCIHC is a multidisciplinary organization based in the United States whose mission is to promote culturally competent professional medical interpreting as a means to support equal access to health care for individuals with limited English proficiency.

14. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE The role of the National Council on Interpreting in Health Care Mission To promote culturally competent professional medical interpreting as a means to support equal access to health care for individuals with limited English proficiency.

15. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE The National Council on Interpreting in Health Care Governance 2 Co-chairs of the Executive Board of the Council 2 Co-chairs of the Executive Board of the Council Secretary Secretary Treasurer Treasurer 2 co-chairs for the 5 committees –Membership –Organizational Development –Outreach –Policy and Research –Standards, Training and Certification

16. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE The NCIHC website: http://www.ncihc.org It provides valuable information regarding: It provides valuable information regarding: Monthly updates involving the interpreter profession Monthly updates involving the interpreter profession Language access resources Language access resources Policy Initiatives Policy Initiatives The NCIHC Working Paper Series The NCIHC Working Paper Series

17. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE The National Code of Ethics for Health Care Interpreters The National Code of Ethics for Health Care Interpreters The National Standards of Practice for Health Care Interpreters The National Standards of Practice for Health Care Interpreters

18. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE References: Fernandez, A. Schillinger D, Grumbach K, Rosenthal A, Stewart AL, Wang F, Perez- Stable EJ. Physician Language Ability and Cultural Competence: An Exploratory Study of Communication with Spanish-speaking Patients. J Gen Intern Med. 2004:19(2):167-174 Flores G, Laws MB, Mayo SJ, Zuckerman B, Abreu M, Medina L, Hart EJ. Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters. Pediatrics. 2003;111(1):6-14 Johnson RL, Saha S, Arbelaez JJ, Beach, MC, Cooper LA. Racial and Ethnic Differences in Patient Perceptions of Bias and Cultural Competence in Health Care. J Gen Intern Med 2004: 19:101-110. Johnson RL, Saha S, Arbelaez JJ, Beach, MC, Cooper LA. Racial and Ethnic Differences in Patient Perceptions of Bias and Cultural Competence in Health Care. J Gen Intern Med 2004: 19:101-110. Flores, G. Language Barriers to Health Care in the United States The New England Journal of Medicine. July 2006, 225-231

19. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE References: Working Together to End Racial and Ethnic Disparities: One Physician at a Time www.ama.assn.org/go/healthdisparities Proceedings of the 2005 White House Conference on Aging Mini-Conference on Health Literacy and Health Disparities, American Medical Association, 2005 www.ama-assn.org/go/aging Language as a Barrier to Health Care for New York City Children in Immigrant Families: Haitian, Russian and Latino Perspectives. A Report of the Division of Health Policy and the New York Forum for Child Health The New York Academy of Medicine, May 2006

20. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE RESOURCES HHS- Office for Civil Rights http://www.hhs.gov/ocr/lep/. HHS- Office for Civil Rights http://www.hhs.gov/ocr/lep/.http://www.hhs.gov/ocr/lep/ The National Health Law Program http://www.healthlaw.org/langaccess/fedadmin.html or http://www.healthlaw.org/langaccess/promisingpractices.html#interpre ters The National Health Law Program http://www.healthlaw.org/langaccess/fedadmin.html or http://www.healthlaw.org/langaccess/promisingpractices.html#interpre ters http://www.healthlaw.org/langaccess/fedadmin.html http://www.healthlaw.org/langaccess/promisingpractices.html#interpre ters http://www.healthlaw.org/langaccess/fedadmin.html http://www.healthlaw.org/langaccess/promisingpractices.html#interpre ters http://www.healthlaw.org/langaccess/stateactivities.html http://www.healthlaw.org/langaccess/stateactivities.html http://www.healthlaw.org/langaccess/stateactivities.html Language Services Action Kit produced by NHeLP and The Access Project. It can be downloaded free from www.accessproject.org Language Services Action Kit produced by NHeLP and The Access Project. It can be downloaded free from www.accessproject.orgwww.accessproject.org

21. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE References: Working Together to End Racial and Ethnic Disparities: One Physician at a Time www.ama.assn.org/go/healthdisparities Proceedings of the 2005 White House Conference on Aging Mini-Conference on Health Literacy and Health Disparities, American Medical Association, 2005 www.ama-assn.org/go/aging Language as a Barrier to Health Care for New York City Children in Immigrant Families: Haitian, Russian and Latino Perspectives. A Report of the Division of Health Policy and the New York Forum for Child Health The New York Academy of Medicine, May 2006

22. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE References: Vasquez, C., Javier RA. The problem with interpreters: Communicating with Spanish-speaking patients. Hospital and Community Psychiatry. Feb 1991, 42 (2) 163-165 Institute of Medicine: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, D.C.: National Academic Press; 2002 Centers for Disease Control and Prevention. Office of Minority Health-Eliminating Racial and Ethnic Health Disparities. www.cdc.gov/omh/AboutUs/disparities.htm or www.cdc.gov/omhd/OMHD@cdc.gov www.cdc.gov/omh/AboutUs/disparities.htm www.cdc.gov/omhd/OMHD@cdc.govwww.cdc.gov/omh/AboutUs/disparities.htm www.cdc.gov/omhd/OMHD@cdc.gov Karliner LS, Perez-Stable EJ, Gildengorin G. The Language Divide. The Importance of Training in the Use of Interpreters for Outpatient Practice. J Gen Intern Med 2004:19(2):175-83

23. Increasing Language Access in Healthcare INTERPRETERS AND TRANSLATORS IN HEALTH CARE INTERPRETERS AND TRANSLATORS IN HEALTH CARE National Council on Interpreting in Health Care (NCIHC) http://www.ncihc.org National Council on Interpreting in Health Care (NCIHC) http://www.ncihc.org http://www.ncihc.org Diversity RX Diversity RX http://www.diversityrx.org/ The California Endowment The California Endowment http://www.calendow.org/ http://www.calendow.org/http://www.calendow.org/ National Health Law Program (NHeLP) National Health Law Program (NHeLP) http://www.healthlaw.org Health and Human Services Office for Civil Rights Health and Human Services Office for Civil Rights http://www.hhs.gov/ocr Office of Minority Health Office of Minority Health http://www.omhrc.gov/OMHRC New York State New York State www.dos.state.ny.us/info/regist er/2006/sep13/pdfs/rules.pdfwww.dos.state.ny.us/info/regist er/2006/sep13/pdfs/rules.pdf> www.dos.state.ny.us/info/regist er/2006/sep13/pdfs/rules.pdf American Translators Association American Translators Association http://www.atanet.org California Health Care Interpreting Association California Health Care Interpreting Association http://chia.ws Massachusetts Medical Interpreter Association Massachusetts Medical Interpreter Association http://www.mmia.org

24. Increasing Language Access in Healthcare Thank you! National Council on Interpreting in Health Care 270 W. Lawrence Street Albany, NY 12208 info@ncihc.org Wilma Alvarado-Little, MA Interpreter@walvarado-little.net